Individual
MR. CARL LEE GREEN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
750 W D AVE, KINGMAN, KS 67068-1266
(620) 532-3147
Mailing address
1015 N FIREFLY CIR, WICHITA, KS 67235-9437
(316) 721-5284
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1500576
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042639
BLUE CROSS/BLUE SHIELD
KS
Enumeration date
05/02/2006
Last updated
07/09/2007
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